Individual
LISA JANE BURNHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSAC, LPC-IT
Contact information
Practice address
115 5TH AVE S STE 504, LA CROSSE, WI 54601-4079
(715) 896-4772
(608) 782-4426
Mailing address
115 5TH AVE S STE 523, LA CROSSE, WI 54601-4018
(715) 896-4772
(608) 782-4426
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
16199-132
WI
101YP2500X
Professional Counselor
Primary
3803-226
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100060087
—
WI
Enumeration date
05/27/2016
Last updated
01/20/2020
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